Anxiety disorders are common, and they pose discomfort and health risks to the person who suffers with symptoms, his family and his co-workers.
The term "anxiety disorders" refers here to the group of conditions which are long-standing and persistent. They are listed under this term in the Diagnostic and Statistical Manual of Psychiatry, Fourth Edition. The presently accepted names of such anxiety disorders are: Generalized Anxiety Disorder, Obsessive-Compulsive Disorder, Post-Traumatic Stress Disorder, Acute Stress Disorder, Panic Disorder, Agoraphobia, Specific Phobia, Social Phobia, Anxiety Disorder Due to General Medical Condition, Substance-Induced Anxiety Disorder, and Anxiety Disorder Not Otherwise Specified. These "anxiety disorders" are different from ordinary "reactive anxiety" which occurs in the normal course of life, for example, due to the stress of moving from one house to another. Such reactive anxiety disorders, without medication, decrease with time, e.g., in one to four weeks.
The term "adjustment disorders with anxiety" refers to conditions listed under this term in the cited Diagnostic and Statistical Manual of Psychiatry, which include the expression of anxiety. These conditions are: Adjustment Disorder with Anxiety, Adjustment Disorder with Mixed Anxiety and Depressed Mood, and Adjustment Disorder with Mixed Disturbance of Emotions and Conduct, in which the emotional symptoms include anxiety.
The term "centrally-acting beta-blockers" as used herein encompasses medications that enter the central nervous system by passage from the bloodstream across the blood-brain barrier, and there block beta-adrenergic receptors. This blockade of beta-adrenergic receptors may provide reliable therapeutic benefits for anxiety disorders, for example, the use of the beta-blocker betaxolol, as described in U.S. Pat. No. 5,798,393 (Swartz 1998). Not all beta-blockers are "centrally-acting beta-blockers" since some do not cross the blood-brain barrier, i.e., atenolol and nadolol.
The medications which have been identified as centrally-acting beta-blockers are: acebutolol,betaxolol, bisopropolol, bopindolol, carvedilol, metoprolol, oxprenolol, propranolol, and timolol. Those beta-blockers include, for each, its racemic mixture, its optical isomer, its immediate-release and sustained-release preparation. Generally, beta-blockers are not recognized by psychiatrists as a medication to treat anxiety disorders.
The term "serotonin-enhancer", as used herein, means medications that increase or prolong serotonergic neurotransmission. For example, they act as a counteraction, an agonist of serotonin at serotonin receptor sites; by preventing the degradation of serotonin, by increasing the formation of serotonin, by preventing the removal of serotonin from the sites (i.e., the synaptic cleft) of the serotonin-reuptake inhibitor (SRI), by prolonging the actions or effects of serotonin, or by diminishing influences that inhibit serotonin release (Lakoski and Aghajanian 1985). Serotonin agonists include buspirone (BuSpar.TM.) gepirone, and ipsapirone. Serotonin precursors, which increase its formation, include L-tryptophan and 5-hydroxytryptophan (5-HTP). Serotonin reuptake inhibitors (SRI) include chlorimipramine (also known as clomipramine and chlorimipramine), citalopram, fluoxetine (Prozac.TM.), fluvoxamine, paroxetine, sertraline, venlafaxine, lamotrigine, and carbamazepine. Agents which diminish influences that inhibit serotonin release include presynaptic serotonin antagonists, which include ritanserin, ketanserin, risperidone, mirtazepine, nefazodone, trazodone, olanzapine, clozapine, serazepine, methysergide, mianserin, and flibaserin. Each agent includes its racemic mixture, optical isomer, immediate-release preparation and sustained-release preparation.
Separately, several centrally-acting beta-blockers and several serotonin enhancers have been identified as providing benefits in the mitigation of anxiety and in the treatment of anxiety disorders.
Benefits in the mitigation of anxiety and in the treatment of anxiety disorders have been reported for several centrally-acting beta blockers (e.g. Swartz 1998; Meibach et al 1987) and several serotonin enhancers (Michaelson et al 1998; Ballenger et al 1998).